Type 1 Diabetes in Emerging Adults in Lebanon: A Mixed Methods Study

Abstract

Emerging adults (EAs) with Type 1 Diabetes (T1D) have poorer diabetes-related outcomes than other age groups, partly due to suboptimal diabetes self-care. No studies have addressed this vulnerable population in Lebanon nor in the Middle East. Filling this gap is needed, considering the unique sociocultural environment and healthcare system of Lebanon, which may influence the health outcomes of this population.

The purpose of this mixed methods study was to describe the experience of EAs living with T1D in Lebanon. The study also aimed to describe their diabetes-related health outcomes, and identify their sociodemographic and clinical predictor variables, while identifying the role of self-care and social support in this relationship. The study’s conceptual model was guided by the Transition, Emerging Adulthood, and Self-Care in Chronic Illness theories.

The study sample consisted of 90 EAs aged 18-29 years with T1D, out of whom 15 participated in the qualitative interviews. Participants were recruited from diabetes clinics and through social media, and data were collected via semi-structured individual interviews. The survey data included sociodemographic and clinical characteristics, diabetes distress (Type 1 Diabetes Distress Scale), social support (Diabetes Care Profile - Social Support scale), and self-care (Self-Care Inventory-Revised scale).

Thematic qualitative analysis was used to identify the themes that describe the experience of the EAs. The overarching theme was “Living with T1D during emerging adulthood: the complex balance of a chemical reaction”, within which the changes that the EAs with T1D experience, the facilitators and barriers of performing adequate self-care, and their ability to reach equilibrium are described. The five main themes included “Breaking of Bonds: Changes and Taking Ownership of their Diabetes”, “The Reactants: Factors Affecting the Diabetes Experience”, “The Catalysts: Facilitators of Self-Care”, “The Inhibitors: Barriers to Self-Care”, and “Aiming for Equilibrium”.

The sample had a median age 21 (IQR, 1925) years, mean diabetes duration of 10.3 ± 4.6 years, and 61% were females. Over two thirds (70 %) had HbA1c levels ≥ 7% (median HbA1c 7.7, IQR 6.6, 8.4); 81.1 % reported a mean diabetes distress score of ≥ 2, indicating moderate to severe diabetes distress; and half of the participants reported at least one acute diabetes complication during the past 6 months. The participants had good levels of diabetes self-care and high levels of social support. HbA1c was predicted by insulin treatment type, age at diagnosis, and self-care, while as diabetes distress was predicted by diabetes knowledge, blood glucose monitoring type, self-care, and social support. Moreover, the incidence of acute diabetes complications was predicted by level of education of the head of household, and self-care was predicted by treatment site, age at diagnosis, and diabetes knowledge. The mediation and moderated-mediation effect of our model was supported, with self-care mediating the association between diabetes knowledge and diabetes distress, and social support moderating this mediation.

The study findings were analyzed from the integrated approach of mixed methods studies and meta-inferences were developed. The study findings validated the suggested framework and provided insight to the clinicians on the experiences of EAs with T1D living in Lebanon to develop future interventions.